title: Unintentional pediatric exposures to central alpha-2 agonists reported to the National Poison Data System.
abstract: OBJECTIVE
  To investigate national trends in unintentional pediatric exposures to 3 common alpha-2 agonists: clonidine, guanfacine, and tizanidine. Secondary objectives were to describe outcomes, symptoms, treatments, and death.
  
  
  METHODS
  Retrospective chart review from the American Association of Poison Control Centers National Poison Data System from January 2000 to December 2011 for unintentional exposure to clonidine, guanfacine, and tizanidine in children ≤ 12 years of age.
  
  
  RESULTS
  From 2000-2011, there was a significant increase (5.9% per year, CI 3.6, 8.2) in unintentional pediatric exposures to National Poison Data System for central alpha-2 agonists. There were 27,825 clonidine exposures (67.3% male, median age: 4 years), 6143 guanfacine exposures (69.8% male, median age: 6 years), and 856 tizanidine exposures (51.9% male, median age: 2 years). Guanfacine had the greatest proportional increase among the medications. Clonidine was associated with the most respiratory (799, 2.9%) and central nervous system symptoms (12,612, 45.3%), as well as the most episodes of bradycardia (2847, 10.2%) and hypotension (2365, 8.5%). Seven-hundred twenty-eight (2.0%) patients were intubated, and 141 patients (0.5%) were administered vasopressors. There were 7 cardiac arrests and 3 deaths from clonidine.
  
  
  CONCLUSIONS
  The number of unintentional pediatric exposures to alpha-2 agonists increased from 2000-2011. Clonidine exposures were the most commonly reported, more symptomatic, and associated with 3 deaths. Despite central nervous system depression, bradycardia, and hypotension being common, the need for intubation and vasopressors was rare.
authors.affiliation: Rocky Mountain Poison and Drug Center, Denver Health, Denver, CO. Electronic address: George.wang@childrenscolorado.org.
authors.forename: George Sam
authors.initials: GS
authors.lastname: Wang
authors.affiliation: Rocky Mountain Poison and Drug Center, Denver Health, Denver, CO.
authors.forename: Marie-Claire
authors.initials: MC
authors.lastname: Le Lait
authors.affiliation: Rocky Mountain Poison and Drug Center, Denver Health, Denver, CO.
authors.forename: Kennon
authors.initials: K
authors.lastname: Heard
mesh_terms: D058647:Adrenergic alpha-2 Receptor Agonists / Q000506:poisoning*; D001919:Bradycardia / Q000139:chemically induced / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D003000:Clonidine / Q000031:analogs & derivatives / Q000506:poisoning; D005260:Female; D016316:Guanfacine / Q000506:poisoning; D006801:Humans; D007022:Hypotension / Q000139:chemically induced / Q000453:epidemiology*; D015994:Incidence; D008297:Male; D011039:Poison Control Centers / Q000706:statistics & numerical data*; D011041:Poisoning / Q000453:epidemiology* / Q000209:etiology; D011159:Population Surveillance; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology
chemical_list: D058647:Adrenergic alpha-2 Receptor Agonists; D016316:Guanfacine; C023754:tizanidine; D003000:Clonidine
keywords: AAPCC; ADHD; American Association of Poison Control Centers; Attention deficit hyperactivity disorder; CNS; Central nervous system; IV; Intravenous; NPDS; National Poison Data System